TECHNICAL FIELD
[001] As known in the state of the art, Transcutaneous Electrical
Nerve Stimulation (TENS) is a well-known and already consecrated modality of
non-medicament and non-invasive treatment for pain control in several
etiologies. Such treatment consists in the placement of electrodes in determined
regions of the human body, and in the application of electric pulses with the
purpose of stimulating the nerves fibers (or nerves); this electrical stimulation
produces an analgesic effect generating a reduction or even total elimination of
the pain.
[002] This treatment mode has already been used in several
clinical scenarios for the treatment of several acute and chronic pain conditions,
and have been well-accepted among health professionals.
[003] TENS is especially indicated in cases of painful disorders of
the locomotor and nervous system, such as: arthritis, muscle inflammation,
fibromyalgia, neuralgia, etc. Furthermore, chronic and recurrent pain, including
visceral pain, such as those caused by dysmenorrhea and oncological origin,
has also been successfully treated by electrostimulation. It is an alternative or
an adjuvant to the medicated analgesic treatment, also reducing the need for
anti-inflammatories.
DESCRIPTION OF THE PRIOR ART
[004] Among the countless electrostimulation equipment known in
the prior art, let us cite the ones disclosed in the following documents: US
4.014.347, US 4.537.195, US 4.693.254, US 5.067.495, US 5.273.033, US
5.620.483, US 5.776.170, US 6.493.588, US 7.922.676 e US 8.700.177.
[005] The usual electrostimulation equipment can be divided into
two large groups: the bench ones, powered by the electric network, and the

portable ones, powered by batteries. For the use of bench equipment, it is
necessary to move the user to the places where the device is available, said
device being usually operated by specialized people (physician or
physiotherapists). On the contrary, the portable equipment is self-applicable
and, after a professional has been indicated, the user can use it himself/herself
in his/her home or work environment.
[006] The portable equipment available in the market involves a
high current consumption, causing the need for frequent exchange or recharge
of the power source batteries. This is a drawback of common equipment.
[007] It is also known that to be effective in the treatment of pain,
electrical stimuli (or pulses) must meet a series of requirements in terms of their
intensity (or amplitude) [in volts (V)], their frequency [in hertz (Hz)], their width
(or duration) [in microseconds (µs)] and its waveform. Pulses can be temporally
organized as continuous or intermittent.
[008] In the scientific literature, there are several reports showing
that analgesia induced by electrical pulses occurs within a very elastic range of
the previously-mentioned parameters.
[009] In fact, the numerous electrostimulation devices known in
the art usually apply electrical pulses whose parameters are found in the
following ranges:
- current intensity: 1-50 mA ( witha 500Ω charge);
- frequency: 1-250 Hz;
- pulse-width (or duration): 10-1000 µs;
- Waveform: single-phase, symmetrical biphasic, or asymmetrical
biphasic;
- stimulation mode: continuous or intermittent.
[010] Although there is extensive literature attesting to the
efficacy of TENS, the mechanism of action is not fully understood, and the
Theory of the Pain Portal and the Central Release of Endorphins are the most

accepted mechanisms of action by the scientific community.
[011] A well-known physiological phenomenon is the one of the
nerve fiber accommodation at the electric stimulus. It is the refractoriness of the
nerve cell membrane when the stimulus is applied in the same phase and with
fixed parameters of intensity, frequency, and pulse width. In this case, the
stimulation ceases to be early effective, and the analgesic effect can be
compromised.
[012] To avoid the nerve fiber accommodation, several strategies
have been developed, among them:
- inversion of the polarity of the electrical pulses;
- waveform change;
- variation of the frequency or intensity (amplitude) of the electrical
pulses.
[013] When the variation of the intensity (amplitude) of the
electrical pulses is used as a strategy to prevent the accommodation of the
nerve fibers, this variation is always done in a regular way in time (according to
the graphical representation of attached Figure 1)
[014] However, even when adopting this measure, there is still
some degree of nerve fiber accommodation, precisely because there is a
regular temporal repetition of said intensity variations. As a function of the
plasticity and adaptive capacity of the cell membranes of the nerve fibers,
regular intervals of variation allow said membranes to adapt, as well as cause
the nerve fibers to be accommodated, thereby reducing the analgesic effect.
[015] This is another inconvenient of the electrostimulation
equipment currently available in the market: the difficulty in avoiding nerve fiber
accommodation when applying the electrical pulses.
[016] Therefore, it would be desirable to develop some kind of
protocol for the application of electrical stimuli that would be able to mitigate the
accommodation of the nerve fibers in a more efficient way, and, therefore, to
guarantee the prolonged analgesic effect.

[017] In addition, it would also be desirable to obtain portable
equipment for electrostimulation application, which consumes less current when
compared to the application of electrical pulses. This low consumption would
allow the use of batteries of smaller size and capacity, reducing the production
costs, increasing its portability and avoiding the need for battery replacement for
an acceptable period of use for various therapeutic sessions. Hence, this
equipment might be disposable.
PURPOSES OF THE INVENTION
[018] To achieve these purposes, an innovative electrostimulation
protocol was developed, in which the intensity variation of the applied electrical
pulses was randomly performed, respecting the limits stimulation efficacy. This
new protocol has proven to be effective in reducing the accommodation of
nerve fiber cell membrane, increasing electrostimulation effectiveness and,
thus, the analgesic effect.
[019] Concurrently, this random variation of electrical pulse
intensity has further allowed to substantially reduce current consumption in the
operations of the electrostimulation equipment. Thus, thanks to the innovative
electrostimulation protocol, it was possible to use disposable coin-shaped
lithium-ion batteries, model CR20XX, which have a sufficient size and charge to
allow the development of a disposable and low-cost equipment.
[020] Only this family of batteries combines the characteristics of
reduced size, sufficient voltage and charge, low environmental impact and low
cost, which makes it possible to dispose of the equipment.
[021] Concurrently, since the use of such disposable batteries is
now possible, the dimensions of the equipment have been substantially
reduced, increasing its portability and ergonomics.
[022] Therefore, the creation of this novel electrostimulation
protocol has made possible the development of a disposable equipment of low

cost, reduced sizes and great portability for the TENS application outside the
hospital environment, capable of serving a greater number of patients who
cannot move to an outpatient unit Therefore, the domestic use or the use in the
work environment itself at any time has been made possible, avoiding
unnecessary displacements, as well as the associated costs.
[023] The generation of this aleatory (or random) variation of the
pulse intensity is performed using a micro-controller and a specially developed
software program, or using analog electronics, from suitable sizing of discrete
components.
[024] In this innovative protocol, other strategies are
simultaneously used in conjunction with random variation of pulse intensity, not
only to further prevent nerve fiber accommodation, but also to make current
consumption even smaller, allowing the now-innovated equipment to be, as
already mentioned, portable and disposable, with low cost, reduced sizes, and
long operational time.
[025] The following strategies are used simultaneously in
conjunction with the aleatory (or random) variation of pulse intensity:
- the use of monopolar pulse bursts, which allow saving battery
charge;
- polarity inversion of the pulse bursts, avoiding muscular fiber
accommodation effect;
- inclusion of intermittent modes of stimulation for the maintenance
of analgesia, once the desired effect has been achieved, saving the battery
charge;
- selection of different bands of electrostimulation, all of them
including the range of random variation.

DESCRIPTION OF THE DRAWINGS
[026] To complement the present description, to better
understand the characteristics of the subject matter of the patent, a set of
drawings accompanies this specification, in which, in an exemplified and non-
limiting manner, the following has been represented:
- Figure 1 is a graphical representation showing the usual strategy
for avoiding the nerve fiber accommodation used in the known
electrostimulation protocols, that is, the use of intensity (amplitude) variation of
the electrical pulses, variation that, to this day, is done regularly over time;
- Figure 2 is another graphical representation, now illustrating the
novel strategy to avoid nerve fiber accommodation, provided by this innovative
electrostimulation protocol, that is, the use of a random variation of electrical
pulse intensity (amplitude), during the application of pulse bursts;
- Figure 3 shows, also by means of a graphical representation, one
of the embodiment of this innovative electrostimulation protocol, where pulse
bursts with a determined duration and with sequentially inverted polarity are
continuously applied;
- Figure 4 illustrates, similarly by means of a graphical
representation, other embodiments of this innovative electrostimulation protocol,
that is, the intermittent mode, according to which pulse bursts are applied with a
determined duration, and with sequentially inverted polarity, although providing
a time interval between said pulse bursts, with a determined duration.
- Figure 5 is a perspective view of the electrostimulation equipment,
in which this innovative stimulation protocol is applied, wherein said equipment
may exhibit any external configuration, among them, the shape of a band, such
as illustrated, as an example, in said figure;
- Figure 6 is a block diagram of this innovative portable
elecrostimulation equipment where said electrostimulation protocol is used,
where said block diagram further includes the electrical scheme of the

equipment;
- finally, Figure 7 is a flowchart of the software, specifically
developed for this innovative electrostimulation protocol.
DETAILED DESCRIPTION OF THE INVENTION
[027] The present application for patent of invention relates to a
“PROCESS FOR ESTABLISHING AN ELECTROSTIMULATION PROTOCOL,
ANDRESPECTIVE ELECTROSTIMULATION PORTABLE EQUIPMENT
USING SAID PROTOCOL”, said electrostimulation process and equipment
being used to control pain in different etiologies, more in particular, painful
disorders of the locomotor and nervous system (among them arthritis, muscle
inflammation, fibromyalgia, neuralgia, etc.), and in cases of chronic and
recurrent pain (among them the ones caused by dysmenorrhea and the ones of
oncological origin).
[028] Initially, with references to the “PROCESS FOR
ESTABILISHING AN ELECTROSTIMULATION PROTOCOL”, said process
provides the development of an electrostimulation protocol in which intensity
variation of the electrical pulses is performed in a random manner, respecting
the limits of stimulation efficacy, to reduce the physiological phenomenon of
nervous fiber accommodation upon receiving stimuli.
[029] More specifically, according to the present process, the
electrical pulses exhibit the shape of a square wave, are monopolar and have a
width (or duration) between 60 µs and 100 µs, preferably 80 µs, frequency
between 40 Hz and 70 Hz, preferably 55 Hz, and, for each intensity level
chosen by the user, there is a random variation occurring from the selected limit
to a lower one, in the range of 10 V, preferably 5 V (with a 500Ωcharge), as
shown in attached Figure 2.
[030] Furthermore, the present process discloses two

embodiments for this innovative electrostimulation protocol, namely, continuous
mode and intermittent mode.
[031] In the continuous mode, shown in the graphical
representation of Figure 3, burst trains lasting 500 milliseconds to 2 seconds,
preferably 1 second, and with sequentially inverted polarity are continuously
applied.
[032] In the intermittent mode, shown in the graphical
representation of Figure 4, pulse bursts lasting from 2 to 4 seconds, preferably
3 seconds, and with sequentially inverted polarity are applied, however there is
a time interval from 2 to 4 seconds, preferably 3 seconds.
[033] In optional embodiments, this innovative protocol discloses
the simultaneous use of other strategies used together with the random
intensity pulse variation, as a complementary way to further reduce nerve fiber
accommodation, as well as to make current consumption even smaller.
[034] Among the strategies simultaneously employed with the
aleatory (or random) variation of the pulse intensity, let us cite the following
ones:
- the use of monopolar pulse bursts, which allow saving battery
charge;
- polarity inversion of the pulse bursts, avoiding muscular fiber
accommodation effect;
- inclusion of intermittent modes of stimulation for the maintenance
of analgesia, once the desired effect has been achieved;
- selection of different bands of electrostimulation, all of them
including the range of random variation.
[035] By means of this new protocol, in which the intensity of the
electric pulses has begun to vary in a random way, it was possible to sensibly
reduce nerve fiber accommodation, increasing the effectiveness of the
electrostimulation and, thus, of the analgesic effect.
[036] Concurrently, this random variation of electric pulse

intensity further allowed a substantial reduction in current consumption in the
operations of the electrostimulation equipment, allowing the use of standard
coin-shaped lithium ion batteries, model CR20XX, which are smaller, cheaper
and of lower load capacity, but sufficient to meet the current lower current
consumption due to random intensity variations, incorporated by this innovative
electric stimulation protocol. Hence, battery replacement becomes
unnecessary.
[037] Thus, since it is now possible to use such common ion-
lithium batteries, it has been possible to substantially reduce the dimensions of
the equipment, which are greater because they are determined by higher
capacity batteries until then necessary to provide electrostimulation operations
of the apparatus.
[038] With references to the novel “ELECTROSTIMULATION
PORTABLE EQUIPMENT USING SAID PROTOCOL”, said equipment can
exhibit any type of external configuration, among them, the one illustrated, as
an example, in Figure 5, according to which the equipment usually consists of a
bandage (1) comprising a central electronic module (2) and two side flaps (3),
which contain, at the lower part, respective electrodes (not shown), suitably
covered by the respective gel layers, that are, in turn, protected by the
respective removable protective sheets (also not shown). The central electronic
module (2) houses the internal components and the electrical circuit of the
equipment, as well as its power supply battery, and an external power button
(4), a led (5) indicating the functioning of the apparatus and one or more control
buttons (6).
[039] Thanks to the previously described innovative
electrostimulation protocol, the power supply battery of this innovative
equipment could now be a disposable coin-shaped lithium-ion battery, model
CR20XX.
[040] As shown in Figure 6, this innovative equipment, shows the
following modules of internal components: Power source module (7), step-up

regulator module (8), micro controller module (9), power supply seal module
(10), boost source module (11), H-bridge module (12), electrode output module
(13), and module for switching off when there is no charge (14).
[041] Figure 7 is a flowchart of the software, specifically
developed for this innovative electrostimulation protocol.
[042] As previously mentioned, by the novel protocol developed
by the Inventor in addition to reducing significantly nerve fiber accommodation,
it was possible to reduce the current consumption in operations carried out by
the electrostimulation equipment, allowing the use of ordinary disposable coin-
shaped lithium ion batteries, model CR20XX, which have smaller sizes, lower
cost and lower capacity in mA/h, but which are sufficient to meet the current
lower consumption required during random intensity variations, determined by
the innovative electric stimulation protocol.

WE CLAIM:
1. A PROCESS FOR ESTABLISHING AN
ELECTROSTIMULATION PROTOCOL, characterized in that it provides a
random intensity variation of the electrical pulses, respecting the stimulation
effectiveness limits, said random variation being comprised, at each chosen
intensity level, within a variation range of 10 V (with 500Ω charge), wherein said
electrical pulses exhibit the shape of a square wave, are monopolar, and have a
width (or duration) ranging between 60 µs and 100 µs, and frequency between
40 Hz and 70 Hz.
2. The PROCESS FOR ESTABLISHING AN
ELECTROSTIMULATION PROTOCOL, according to claim 1, characterized in
that said random intensity variation of the electrical pulses is preferably
comprised in the range of 5 V (with 500 Ωcharge).
3. The PROCESS FOR ESTABLISHING AN
ELECTROSTIMULATION PROTOCOL, according to claim 1, characterized in
that said width (or duration) of the electrical pulses is preferably 80 µs .
4. The PROCESS FOR ESTABLISHING AN
ELECTROSTIMULATION PROTOCOL, according to claim 1, characterized in
that said frequency of the electrical pulses is preferably 55 Hz.
5. The PROCESS FOR ESTABLISHING AN
ELECTROSTIMULATION PROTOCOL, according to claim 1, characterized in
that it provides two electrostimulation modes, namely, continuous mode and
intermittent mode.
6. The PROCESS FOR ESTABLISHING AN
ELECTROSTIMULATION PROTOCOL, according to claims 1 and 5,

characterized in that, pulse bursts are continuously applied, in a continuous
mode, with duration from 500 milliseconds to 2 seconds, and with sequentially
inverted polarity.
7. The PROCESS FOR ESTABLISHING AN
ELECTROSTIMULATION PROTOCOL, according to claim 6, characterized in
that said pulse bursts exhibit preferably a duration of 1 second.
8. The PROCESS FOR ESTABLISHING AN
ELECTROSTIMULATION PROTOCOL, according to claims 1 and 5,
characterized in that pulse bursts lasting 2-4 seconds and with sequentially
inverted polarity, with a time intervals between the pulse bursts, are applied in
an intermittent fashion, wherein said interval lasts 2-4 seconds.
9. The PROCESS FOR ESTABLISHING AN
ELECTROSTIMULATION PROTOCOL, according to claim 8, characterized in
that said pulse bursts exhibit preferably a duration of 3 second.

10. The PROCESS FOR ESTABLISHING AN
ELECTROSTIMULATION PROTOCOL, according to claim 8, characterized in
that said time interval between the pulse bursts exhibits preferably a duration of
3 second.
11. The PROCESS FOR ESTABLISHING AN
ELECTROSTIMULATION PROTOCOL, according to claim 1, characterized in
that it optionally discloses the simultaneous use of other strategies both to avoid
the nerve fiber accommodation and to reduce current consumption, used
together with the random variation of the pulse intensity.
12. The PROCESS FOR ESTABLISHING AN
ELECTROSTIMULATION PROTOCOL, according to claims 1 and 11,

characterized in that one of said strategy is the use of monopolar pulse bursts.
13. The PROCESS FOR ESTABLISHING AN
ELECTROSTIMULATION PROTOCOL, according to claims 1 and 11,
characterized in that the other of said strategies is pulse burst polarity inversion.
14. The PROCESS FOR ESTABLISHING AN
ELECTROSTIMULATION PROTOCOL, according to claims 1 and 11,
characterized in that one of said strategy is the addition of intermittent
stimulation modes.
15. The PROCESS FOR ESTABLISHING AN
ELECTROSTIMULATION PROTOCOL, according to claims 1 and 11,
characterized in that said strategies comprise the selection of different
electrostimulation ranges, wherein all of them include a random variation range.
16. An ELECTROSTIMULATION PORTABLE EQUIPMENT USING
SAID PROTOCOL, of the type consisting of a bandage (1) comprising a central
electronic module (2) and two side flaps (3), which house the respective
electrodes, suitably covered by the respective gel layers, protected by the
respective removable protective sheets, said central electronic module ( 2)
housing the internal components and the electrical circuit of the equipment, as
well as its power supply, wherein, in addition to an on-off button (4) and a led
(5), signalizing that the equipment is working, one or more control buttons (6)
can be externally provided, characterized in that said battery is a non-
rechargeable disposable power battery, preferably a CR20XX coin-shaped ion-
lithium battery, and in that it houses the following internal components: Power
source module (7), step-up regulator module (8), micro controller module (9),
power supply seal module (10), boost source module (11), H-bridge module
(12), electrode output module (13), and module for switching off when there is

no charge (14).
17. The ELECTROSTIMULATION PORTABLE EQUIPMENT
USING SAID PROTOCOL, according to claim 16, characterized in that said
battery is preferably a 3V one.
18. The ELECTROSTIMULATION PORTABLE EQUIPMENT
USING SAID PROTOCOL, according to claim 16, characterized in that it
comprises the electrical scheme shown in Figure.
19. The ELECTROSTIMULATION PORTABLE EQUIPMENT
USING SAID PROTOCOL, according to claim 16, characterized in that it
comprises the flowchart shown in Figure 7.